# Prehabilitative high-intensity interval training and resistance exercise in patients prior allogeneic stem cell transplantation PMID: 38086868 Journal: Scientific reports Published: 2023-12-12 Authors: Kuehl R, Feyer J, Limbach M, Pahl A, Stoelzel F, Beck H, Wegner A, Rosenberger F, Dreger P, Luft T, Wiskemann J ## Question Is a supervised moderate-to-high intensity HIIT plus resistance exercise prehabilitation program safe, feasible, acceptable, and preliminarily effective for improving cardiorespiratory fitness, muscle strength, quality of life, and fatigue in patients before allogeneic stem cell transplantation? ## Summary This multicenter single-arm pilot study tested supervised prehabilitation with HIIT plus moderate-to-high intensity resistance exercise in patients with hematological cancer scheduled for allogeneic stem cell transplantation. The intervention was difficult to recruit for because transplant scheduling left little time before admission, but enrolled participants showed high exercise adherence, no reported adverse events, high enjoyment, and significant improvements in VO2peak, peak power output, 6-minute walk distance, some strength measures, physical functioning, fatigue, and dyspnea. ## Population - Sixteen adults with hematological cancer scheduled for allogeneic stem cell transplantation. - Sample size: 16 - Age: 55.3 +/- 10.8 years; range 28-69 - Sex: 12 male, 4 female - Fitness level: Not systematically intensely training; baseline VO2peak 20.4 ml/kg/min. - Health status: Hematological cancer before allogeneic stem cell transplantation. ## Methodology - Multicenter prospective single-arm pilot study. - 4 to 12 weeks planned before allo-HCT; actual intervention length median 4.4 weeks, mean 5.1 weeks, range 1.4-11.6 weeks. - National Center for Tumor Diseases and university hospital centers in Germany, plus certified exercise facilities. ## Protocol - Supervised prehabilitation HIIT plus resistance exercise. - Modality: Bicycle ergometer HIIT followed by resistance machines/free weights. - Work intervals: 1 minute. - Recovery: 1 minute at 50% PPO. - Sets or repetitions: 8 HIIT intervals; 4-6 resistance exercises, 2 x 12 repetitions. - Intensity: HIIT 90-100% PPO after two 70% PPO familiarization sessions; resistance exercise 60-80% 1RM. - Session duration: HIIT approximately 26-31 minutes plus 30 minutes resistance exercise. - Frequency: 2 sessions per week. - Program length: 4-12 weeks planned before allo-HCT. - Progression: First two sessions at lower intensity; reductions to tolerable intensity or based on thrombocyte/hemoglobin rules. ## Outcomes ### Recruitment Status: worse/safety concern The study intended to include 30 patients but included 16 and stopped early because of low recruitment. ### HIIT adherence Status: improved HIIT adherence was high, with 92% adherence and mean 7.4 of 8 intervals completed per exercise session. ### VO2peak Status: improved VO2peak increased from 20.4 to 23.4 ml/kg/min. Median improvement 2.15 ml/kg/min; z=-2.34, p=0.019, 95% CI 0.67 to 5.35, d=1.6 ### Peak power output Status: improved Peak power output increased from 117 to 131.2 W. Median improvement 15 W; z=-2.56, p=0.010, 95% CI 5.04 to 23.53 ### 6-minute walk distance Status: improved 6-minute walk distance increased from 558.8 to 608.6 m. Median improvement 30.5 m; z=-2.03, p=0.043 ### Patient-reported outcomes Status: mixed Physical functioning, role functioning, emotional functioning, fatigue, dyspnea, physical fatigue, and reduced activity improved significantly; several other QOL/fatigue domains did not. Physical functioning p=0.01; role functioning p=0.041; emotional functioning p=0.004; fatigue p=0.007; dyspnea p=0.024; MFI physical fatigue p=0.03; MFI reduced activity p=0.013 ### Safety Status: mixed No adverse events were reported, but some sessions ended prematurely or required modification and 8 sessions were rated overstraining. 112/128 feedback sessions, or 87.5%, were without complaints. ## Practical Insights - A short, supervised 1:1 cycling HIIT format with resistance training can be tolerated by selected allo-HCT candidates under close medical and exercise-specialist monitoring. - Recruitment and timing are major barriers when exercise starts only after allo-HCT is scheduled. - Familiarization at lower intensity and symptom-based intensity reduction are important in medically complex populations. - This study informs clinical safety boundaries more than general consumer HIIT programming. ## Limitations - Low recruitment and early study stop - Small sample - Single-arm design - No control group - Variable intervention duration - Combined HIIT and resistance exercise prevents attribution to HIIT alone - Findings limited to selected patients able to attend supervised sessions ## Safety And Adherence - No adverse events were reported. - Four sessions had premature endings: two during HIIT because of exhaustion and palpitations, and two during resistance exercise because of shoulder pain and lack of energy/weakness. - Five sessions required reduced intensity or termination of specific exercises. - Seven sessions involved discomfort such as vertigo directly after strain or exhaustion. - Pain associated with the last training session was reported at the beginning of eight sessions. - Exercise was contraindicated during fever, acute infections, thrombocytes below 15000/uL, or hemoglobin below 8 g/dl. ## Original Sources - [PubMed](https://pubmed.ncbi.nlm.nih.gov/38086868/) (pubmed) - [DOI](https://doi.org/10.1038/s41598-023-49420-7) (doi) - [PMC full text](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10716116/) (full text) ## Agent Guidance Preserve the paper-level scope of this note. Do not generalize beyond the population, protocol, measured outcomes, and limitations above.